嗜酸粒细胞黏蛋白性鼻-鼻窦炎的临床特征  

Clinical features of eosinophilic mucin rhinosinusitis

作　　者：费捷[1] 李继红[1] 袁媛[1] 周卫东[1] 

机构地区：[1]南京医科大学附属无锡市人民医院耳鼻咽喉科,江苏无锡214023

出　　处：《中国中西医结合耳鼻咽喉科杂志》2013年第5期348-350,328,共4页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的研究嗜酸粒细胞黏蛋白性鼻一鼻窦炎（EMRS）的临床特征。方法回顾性分析EMRS患者的临床特征，包括性别、年龄、症状、实验室检查、影像学表现、病理结果、治疗及预后。结果12例EMRS,~,者男性7例、女性5例；年龄9～54岁；单N7例、双侧5例；均具有慢性鼻鼻窦炎伴息肉的表现。8N变应原皮肤点刺试验阳性，6N血清总IgE升高，8N外周血嗜酸粒细胞升高。鼻窦CT多表现为受累鼻窦腔内中间呈斑片状或云雾状高密度影。鼻窦分泌物病理切片可见大量嗜酸细胞，真菌染色及真菌培养均为阴性。所有患者均行鼻内镜手术，术后口服及鼻用糖皮质激素治疗。随访1年后有3例复发。结论EMRS是一种特殊类型的慢性鼻-鼻窦炎，诊断需依靠术后的病理检查，鼻内镜手术及激素治疗是主要治疗手段。Objective To study the clinical features of eosinophilic mucin rhinosinusitis （EMRS）. Methods EMRS patients were enrolled in the retrospective study. Data including sex, age, symptoms, laboratory examinations, imaging findings, pathological presentations, treatments and prognosis were analyzed. Results Twelve patients were diagnosed as EMRS, including seven males and five females, aged from nine to fifty-four years. All subjects presented chronic rhinosinusitis with nasal polyps, in which seven were unilateral and five were bilateral disease. Eight subjects showed positive skin prick test. Elevated serum total IgE and eosinophil count were found in six cases and eight cases respectively. Most of the patients showed patchy or nebulous increased attenuation within the completely opacified sinuses in CT scan. Histopathological examination of the eosinophilic mucus revealed abundant eosinophilic infiltration but no obvious fungal hyphae, and fungal culture was negative. All EMRS patients received endoscopic sinus surgery, and oral and topical corticosteroids were administered postoperatively. Three patients recurred within one year after surgery. Conclusion EMRS is a subgroup of chronic rhinosinusitis with special characteristics. Prompt and accurate diagnosis of EMRS is dependent on histopathological examination postoperatively. Surgical therapy along with corticosteroid were the main strategy for management.

关 键 词：鼻窦炎 鼻息肉 嗜酸粒细胞 黏蛋白 真菌 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]